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{ timecode: 0, handler: 'blob', id: 1, data: {text: 'DAVID WHITE: As all of you know, of course, Charles Dickson is responsible for all of the technical assistance programs at CTAA. Which really kind of means that Expo programs, the National Transit '}},
{ timecode: 16, handler: 'blob', id: 2, data: {text: 'Resource Center. Charlie has had a hand in all of this over the years and none of it would have been possible without him. I think we really owe Charlie a really huge round of applause for his work. '}},
{ timecode: 38, handler: 'blob', id: 3, data: {text: 'He has put together a great panel today on collaboration. Going back again to the morning, that is really what this is all about because as we learn there are a great many different folks in here '}},
{ timecode: 52, handler: 'blob', id: 4, data: {text: 'representing many different constituencies, transportation providers, health care providers, funding sources, when you put that all together I think that is how this is job is going to get done. I am '}},
{ timecode: 66, handler: 'blob', id: 5, data: {text: 'going to turn the program over to Charlie here in a second and his fine panel. Before I do that I want to remind everybody once again to please turn off your cell phone now that we have all had them '}},
{ timecode: 80, handler: 'blob', id: 6, data: {text: 'on during the lunch hour or put them on vibrate. We are taped again. There were—we did get some handouts from the last panel that are now in the back that you can get on your way out. And I '}},
{ timecode: 101, handler: 'blob', id: 7, data: {text: 'think that should cover all of the housekeeping issues. We will have a break at 3 o’clock and then the last panel will start at 3:30. So that is about it for the afternoon. With that I will turn '}},
{ timecode: 120, handler: 'blob', id: 8, data: {text: 'it over to Charlie. CHARLES DICKSON: Thanks Dave, I appreciate that. Good afternoon everybody. This afternoon this panel is going to talk about collaboration, and I think if we listened to Dale '}},
{ timecode: 134, handler: 'blob', id: 9, data: {text: 'Marisco’s presentation this morning and the panel that followed on senior mobility, we understand that collaboration is really what it’s all about. It was very interesting, I think, when '}},
{ timecode: 147, handler: 'blob', id: 10, data: {text: 'Dave did his little census here this morning and asked how many people carry people to dialysis and how many people were providing transportation to cancer treatment. Almost all the hands from all the '}},
{ timecode: 162, handler: 'blob', id: 11, data: {text: 'providers went up. And this afternoon we’ve got representatives with us who are going to talk about how in their home states and their home regions they’ve put together these '}},
{ timecode: 172, handler: 'blob', id: 12, data: {text: 'collaborations to provide transportation to dialysis clinics and for cancer treatment. Let me just briefly introduce the panel and then we’ll get into it. Sitting down next to Mr. White we have '}},
{ timecode: 188, handler: 'blob', id: 13, data: {text: 'Michelle Hansen. We heard a little bit from Michelle earlier. Michelle is a senior program specialist with the American Cancer Society in the Midwest Division, her job entails helping people access '}},
{ timecode: 203, handler: 'blob', id: 14, data: {text: 'medical care by designing and developing innovative medical transportation and lobbying programs, and she has 9 years experience in transportation. Sitting to Michelle’s right is Ron Baumgart. '}},
{ timecode: 217, handler: 'blob', id: 15, data: {text: 'Ron didn’t provide me with his bio, but I’ve known Ron for a number of years now, and in addition to running River Cities Transit in Pierre, South Dakota, which he has done for a number of '}},
{ timecode: 228, handler: 'blob', id: 16, data: {text: 'years, and has built that from a system that was really on the brink of dissolution to one of the finest transit programs in the United States, and in fact, was the Community Transportation Rural '}},
{ timecode: 243, handler: 'blob', id: 17, data: {text: 'Program of the year in 2006, he has done a great job. In addition to that, he also has pursued another interest that’s dear to my heart, and that’s farming, but I think he left the farming '}},
{ timecode: 258, handler: 'blob', id: 18, data: {text: 'field for transportation; is that right, Ron? The person to my immediate left probably needs no introduction for most of you. She’s Patricia Weaver, Pat Weaver, from the Kansas University '}},
{ timecode: 271, handler: 'blob', id: 19, data: {text: 'Transportation Center, and there Pat is the Associate Director of Outreach and Technology Transfer at the K.U. Transportation Research Institute and Executive Director and Research Scientist at the '}},
{ timecode: 285, handler: 'blob', id: 20, data: {text: 'Kansas University Transportation Center where she’s worked since 1982. So, she actually has more longevity in this field than I do. And if anybody has worked in rural transit at any point in any '}},
{ timecode: 301, handler: 'blob', id: 21, data: {text: 'time in the last 20 or 30 years in the country, they know Pat is one of the founders of National Rural Transportation Systems Program and a longtime leader of the RTAP program in Kansas. She is going '}},
{ timecode: 314, handler: 'blob', id: 22, data: {text: 'to talk to us a little bit about a very exciting project that she has undertaken in Kansas. But first I’d like to start my questions with Michelle. Michelle, you work for the American Cancer '}},
{ timecode: 328, handler: 'blob', id: 23, data: {text: 'Society, and you’re the one person up here who is not a transportation provider. Can you just tell us a little bit about what the American Cancer Society does and how that has now come around to '}},
{ timecode: 341, handler: 'blob', id: 24, data: {text: 'having a transportation program? MICHELLE HANSEN: Well, certainly. On the broader scope, the American Cancer Society does a lot of valuable research provides funding for key cancer research. We do a '}},
{ timecode: 352, handler: 'blob', id: 25, data: {text: 'certain amount of prevent—well a lot of prevention and detection efforts to really help people assess their risk for cancer. And then there’s also issues that are under what we call '}},
{ timecode: 365, handler: 'blob', id: 26, data: {text: 'quality of life when someone is diagnosed with cancer what do they have do to receive the treatment that they need. How can we help them with a wide array of issues that they might confront now? And '}},
{ timecode: 380, handler: 'blob', id: 27, data: {text: 'transportation, assess to treatment has been one of the key barriers that our cancer patients have seen, I would say, in the last 10 years. That importance, that issue of transportation for cancer '}},
{ timecode: 394, handler: 'blob', id: 28, data: {text: 'patients has increased and it’s now in the top tow barriers to actually getting the treatment and one of the top two financial concerns of a cancer patient. Just because of the chronic condition '}},
{ timecode: 406, handler: 'blob', id: 29, data: {text: 'of cancer and the recurring treatments that a cancer patient go through much like dialysis, where it may be everyday, Monday through Friday, for 4 to 6 weeks, that can really take its toll and '}},
{ timecode: 421, handler: 'blob', id: 30, data: {text: 'completely change or help completely change that cancer patient’s financial picture. So we’re very interested in doing all that we could to try to address that barrier and make sure that '}},
{ timecode: 432, handler: 'blob', id: 31, data: {text: 'everyone can get to the treatment that they are so in need of. In terms of this project. The Cancer Society—it was mentioned earlier, we do have some great volunteer programs such as Road to '}},
{ timecode: 446, handler: 'blob', id: 32, data: {text: 'Recovery. Road to Recovery is very successful in some urban areas most successful in suburban areas and then when you get to rural areas it can be moderately successful. The issue we were facing in '}},
{ timecode: 460, handler: 'blob', id: 33, data: {text: 'South Dakota was extreme frontier rural distances in which it was about 200 miles one-way. If you look at the state of South Dakota, all the key treatment centers are on the eastern or western edge. '}},
{ timecode: 476, handler: 'blob', id: 34, data: {text: 'It’s mostly on eastern edge. There is one on the western edge. So that means that patients are isolated from their treatment center in a much more dramatic fashion than elsewhere and the idea of '}},
{ timecode: 488, handler: 'blob', id: 35, data: {text: 'free transportation, well it is an expensive program and so they’re trying to figure out a way that we can really help get those patients that were isolated to the treatment that they so needed. '}},
{ timecode: 505, handler: 'blob', id: 36, data: {text: 'CHARLES DICKSON: I understand that you have a partnership with Ron to help provide some of that transportation. Ron can you just talk a little bit about how you work with American Cancer Society to '}},
{ timecode: 518, handler: 'blob', id: 37, data: {text: 'provide services to some of the clients in South Dakota. RON BAUMGART: Okay, I’ll certainly do that. If I could give just a little history first only being involved in transportation since 2001. '}},
{ timecode: 530, handler: 'blob', id: 38, data: {text: 'We come from central South Dakota. Our service area is about 100 miles around the city of Pierre and Fort Pierre and I have to use that term very loosely, population about 14,000 people. Our whole '}},
{ timecode: 542, handler: 'blob', id: 39, data: {text: 'service area under 30,000. I have been there all of my life and one of the things that I realize and happen to run into and is annoying certain people that many people were determining their '}},
{ timecode: 554, handler: 'blob', id: 40, data: {text: 'treatment, whether it be for cancer or something else by whether they could or could not access certain treatments, and in the cases where they couldn’t or did not think they could afford to '}},
{ timecode: 565, handler: 'blob', id: 41, data: {text: 'they were probably getting less than what they should or could have gotten if they could get to major medical centers and certainly that became a concern. Also, we’re very fortunate to work with '}},
{ timecode: 579, handler: 'blob', id: 42, data: {text: 'Michelle. Actually, she put it together, a team that we ended up coming, one of the CTA institute teams that was sort of our focus from South Dakota. How would we reach the major medical centers from '}},
{ timecode: 593, handler: 'blob', id: 43, data: {text: 'some very rural areas? So that’s sort of where we’re at we have started that about a year ago I guess. Previous to that our transit agency did receive one grant from the American Cancer '}},
{ timecode: 606, handler: 'blob', id: 44, data: {text: 'Society to provide treatment to the major medical centers which is Sioux Falls, Rapid City, Mitchell, all of them, almost 200 to 225 miles away from Central South Dakota. We are licensed non-emergency '}},
{ timecode: 624, handler: 'blob', id: 45, data: {text: 'Medicaid providers so we use every funding source available to try to provide this service. Our partnership with the American Cancer Society is just another way that once in a while we can call on '}},
{ timecode: 640, handler: 'blob', id: 46, data: {text: 'them for some additional help in getting that transportation provided. CHARLES DICKSON: What would a typical trip be for this service then? RON BAUMGART: Well, through our agreement, what we’ve '}},
{ timecode: 651, handler: 'blob', id: 47, data: {text: 'tried to do, and I guess I probably need to back up a little bit. The other thing that excites me, a few years ago our clinics, in our area at least, there has never been busing of any kind in Central '}},
{ timecode: 663, handler: 'blob', id: 48, data: {text: 'South Dakota school busing or anything like that so transit, the concept of public transit was just almost nonexistent. When you went to clinics or health care providers they just didn’t see any '}},
{ timecode: 679, handler: 'blob', id: 49, data: {text: 'value, they didn’t think there was a need or anything like that, and that’s really changed in the last couple years to where the major medical centers are seeing the needs to get the folks '}},
{ timecode: 689, handler: 'blob', id: 50, data: {text: 'from our areas and the small clinics to the treatment centers and things. Through all of that we have tried to target two days in Rapid City for right now—or Sioux Falls excuse me, in this pilot '}},
{ timecode: 701, handler: 'blob', id: 51, data: {text: 'project where we provide very reasonable ride to Sioux Falls on Tuesdays and Thursdays and that’s 20 to 25 dollars per person, so that’s for 400 some miles round trip that is pretty '}},
{ timecode: 718, handler: 'blob', id: 52, data: {text: 'reasonable. CHARLES DICKSON: So tell us again, how far is it from Pierre to Sioux Falls? RON BAUMGART: 225 miles each way. MICHELLE HANSEN: We also now have a second transit agency that is joined and '}},
{ timecode: 729, handler: 'blob', id: 53, data: {text: 'is also working to provide this sort of like block scheduling to key treatment facilities in Sioux Falls from Vermillion and that is, I think, a 60 mile distance. Again, it’s a reduced rates. It '}},
{ timecode: 742, handler: 'blob', id: 54, data: {text: 'is sort of like good old fashioned carpooling where we really try to fill the vehicle up, that is sort of our long-vision, to pack it, so that we can really start saving on some costs and make this I '}},
{ timecode: 754, handler: 'blob', id: 55, data: {text: 'guess not as a—a more feasible long term existence project. CHARLES DICKSON: I want to come back and talk to you a little bit more about that, but let’s hear from Pat here for a second. '}},
{ timecode: 767, handler: 'blob', id: 56, data: {text: 'Pat, you also represent a rather rural state. PAT WEAVER: Right. Right. Some of that ditto. CHARLES DICKSON: There are a lot of distances in Kansas, but you’ve been focusing on dialysis '}},
{ timecode: 779, handler: 'blob', id: 57, data: {text: 'transportation. How did dialysis transportation become the focus of this statewide research project and also the Wichita task force? PAT WEAVER: Well, first of all I’d like to just acknowledge '}},
{ timecode: 792, handler: 'blob', id: 58, data: {text: 'Valery Powers from Wichita, Sedgwick County Council on—or Department of Aging and she was really very instrumental in the Wichita taskforce and she’s gone through some very significant '}},
{ timecode: 807, handler: 'blob', id: 59, data: {text: 'health challenges over the last 3 or 4 months, and so just wanted to recognize the work that she’s done on that project. We were involved in looking at dialysis from kind of a statewide level. '}},
{ timecode: 821, handler: 'blob', id: 60, data: {text: 'It developed out of a couple of things. One was the Kansas United We Ride Project and the state council looking at non-emergency medical transportation and discussion of dialysis as c certainly not '}},
{ timecode: 837, handler: 'blob', id: 61, data: {text: 'the only NEMT issue in the state, but because of its frequency of service within the week and ongoing nature of that, really kind of looking at the characteristics and trying to quantify a little bit. '}},
{ timecode: 854, handler: 'blob', id: 62, data: {text: 'We have a lot of stories, a lot of anecdotal evidence from transit providers and others in the state about the challenges of dialysis transportation but when we kind of tried to look at other studies '}},
{ timecode: 868, handler: 'blob', id: 63, data: {text: 'that had been done to look at from the patient’s perspective, from the clinic perspective what the issues were we did not find very much and we thought this would be an opportunity to maybe kind '}},
{ timecode: 883, handler: 'blob', id: 64, data: {text: 'of look at that. A second component of that was also in doing some work with the American Bus Association, and their interest in looking at whether intercity bus transportation, whether partnerships '}},
{ timecode: 897, handler: 'blob', id: 65, data: {text: 'with intercity bus and serving dialysis transportation needs would be a possibility. They were looking at it, interested, certainly from the national perspective. Within the transportation center we '}},
{ timecode: 911, handler: 'blob', id: 66, data: {text: 'undertook the study to look specifically at Kansas and try to identify that, so the kind of the scope of the study was to select some dialysis clinics from around the state and survey patients as well '}},
{ timecode: 930, handler: 'blob', id: 67, data: {text: 'as the social workers that serve those clinics and the transit providers that are in those areas. We had in Kansas there are 105 counties we have a total of 47 clinics. But those clinics are located '}},
{ timecode: 946, handler: 'blob', id: 68, data: {text: 'in only 27 of the counties, and much like Michelle and Ron indicated, they are fairly focused on the mainly on the eastern part of the state and the northwest quadrant—well really on '}},
{ timecode: 961, handler: 'blob', id: 69, data: {text: 'the—from the—if you kind of split the state down the middle and the western side there are only 11 clinics spread out through the state and we have a lot of counties that have no clinics '}},
{ timecode: 978, handler: 'blob', id: 70, data: {text: 'based there. Kansas like South Dakota, 200 by 400 miles so in the northwest part of the state have one clinic serving pretty much that whole northwest quadrant of the state, so the, you know, the trip '}},
{ timecode: 995, handler: 'blob', id: 71, data: {text: 'distance can be well over 100 miles. When we surveyed those patients we found that the average trip distance—one way trip distance was around 60 miles or so, and so that, you know, in general 3 '}},
{ timecode: 1010, handler: 'blob', id: 72, data: {text: 'times a week, you know, for life, so that was kind of the genesis of that survey and that work. CHARLES DICKSON: Can you tell us a little bit about the major themes that came out of that work? PAT '}},
{ timecode: 1026, handler: 'blob', id: 73, data: {text: 'WEAVER: Yeah. One of the things that, like I said, we surveyed the patients and the social workers and the transit providers, and one of the things that we were really surprised to see out of that was '}},
{ timecode: 1045, handler: 'blob', id: 74, data: {text: 'that the majority of the patients reported that they had adequate access to transportation and, you know. In reflecting on that, which was a big surprise to—and kind of contradictory to, '}},
{ timecode: 1060, handler: 'blob', id: 75, data: {text: 'everything that we see and hear and, in talking with someone and, the primary mode of transportation for those individuals, as you might suspect, was either driving themselves or using family and '}},
{ timecode: 1077, handler: 'blob', id: 76, data: {text: 'friends to get themselves to service. Often family and friends. Another component or future research might be to survey those family and friends, you know, in terms of the service that they’re '}},
{ timecode: 1096, handler: 'blob', id: 77, data: {text: 'providing and what, you know, kind of a challenges that presents to the individual. The other theme in that, in terms of that question saying that they have adequate access to, you know, to their '}},
{ timecode: 1110, handler: 'blob', id: 78, data: {text: 'clinics, but then in reading initial comments, you see that often people, will say that they, you know, they’re able to drive themselves or they can get family and friends, but when they '}},
{ timecode: 1125, handler: 'blob', id: 79, data: {text: 'elaborate on their circumstances, you see immense challenges. So someone who says that her vision is very limited and improves somewhat after dialysis so she feels like she can, she can drive, drive '}},
{ timecode: 1142, handler: 'blob', id: 80, data: {text: 'home from treatment. Often the social workers, when they were surveyed, a lot of concern expressed for those individuals in terms of their ability to drive after their treatment, but still people '}},
{ timecode: 1156, handler: 'blob', id: 81, data: {text: 'transporting themselves home. I think that that was, that was one of the major things coming out of that. I think in terms of who those individuals are looking to for information about transportation, '}},
{ timecode: 1175, handler: 'blob', id: 82, data: {text: 'they most commonly sited family or friends, so they weren’t talking to their social workers who all indicated that they were very willing and interested in giving them information about '}},
{ timecode: 1187, handler: 'blob', id: 83, data: {text: 'transportation and they weren’t talking to transportation providers to find out if there was transportation available. Like I mentioned I think another theme in terms of the interviews with the '}},
{ timecode: 1201, handler: 'blob', id: 84, data: {text: 'social workers was just a lot of concern for their case load and the individuals that, you know, are receiving treatment and that they are driving themselves and that that’s often not a good '}},
{ timecode: 1215, handler: 'blob', id: 85, data: {text: 'solution. I think the—the comment that we heard was kind of the crisis waiting to happen, so that, you know, things, people have found ways to get themselves to dialysis treatment, but '}},
{ timecode: 1231, handler: 'blob', id: 86, data: {text: 'it’s really, you know, a situation in which, you know, either, you know, their car breaks down or they are not able to drive, so it’s that kind of the emergency kind of situation that I '}},
{ timecode: 1244, handler: 'blob', id: 87, data: {text: 'come about. Another theme was the just the cost of the transportation service and what that costs the individual, the individual household or on the side of the transit providers, kind of the ability '}},
{ timecode: 1263, handler: 'blob', id: 88, data: {text: 'to provide that service on an ongoing basis over long distances and particularly within rural states typically a very small providers. They may have these one or two vehicles that they take that '}},
{ timecode: 1275, handler: 'blob', id: 89, data: {text: 'vehicle out of service for a dialysis treatment there’s no service left in that community for other individuals. And then I think just, you know, kind of the logistics of it. Just the either '}},
{ timecode: 1292, handler: 'blob', id: 90, data: {text: 'crossing state lines or even county boundaries and in many cases and the inability to do that. Then the inadequate hours of service or days of service so that even if a transit agency is able to '}},
{ timecode: 1308, handler: 'blob', id: 91, data: {text: 'provide that, they don’t operate on hours that really can meet the dialysis treatment needs. CHARLES DICKSON: Those are a lot of challenges. That really is in – I have a follow-up '}},
{ timecode: 1323, handler: 'blob', id: 92, data: {text: 'question. I saw Michelle nodding her head a lot during your answers so I’ll come back to her too. Have you actually been able to institute any changes in the way services have been provided in '}},
{ timecode: 1335, handler: 'blob', id: 93, data: {text: 'these communities in Kansas as a result of this study? PAT WEAVER: Well, the timing is such that with the study that’s just coming to a conclusion so a lot of these results are just coming up. '}},
{ timecode: 1348, handler: 'blob', id: 94, data: {text: 'I’ll talk just a little bit about the taskforce in Wichita and what they have accomplished. Because in the Wichita area, obviously that’s a more urbanized area, but they do have a number '}},
{ timecode: 1364, handler: 'blob', id: 95, data: {text: 'of people from rural communities traveling into Wichita, and so a forum was convened last November which included the Department on Aging for the county, the Health Department, several of the dialysis '}},
{ timecode: 1381, handler: 'blob', id: 96, data: {text: 'clinics representatives either from the corporation or the social worker generally and the transit providers. With that group there was, you know, the kind of an inventory of who was providing service '}},
{ timecode: 1397, handler: 'blob', id: 97, data: {text: 'currently, what’s some of the limitations were and then the brainstorming session in terms of what kind of collaboration could take place and kind of a laundry list of things were developed. You '}},
{ timecode: 1410, handler: 'blob', id: 98, data: {text: 'know some of them are in kind of the advocacy side and others on more education and then just getting down to the actual provision of the service. On the advocacy side and kind of a fact sheet that '}},
{ timecode: 1424, handler: 'blob', id: 99, data: {text: 'was developed for local legislators to look at what the challenges were for the Wichita area and the kinds of things that needed to happen. Another kind of fact sheet was developed for the social '}},
{ timecode: 1439, handler: 'blob', id: 100, data: {text: 'workers in terms of additional information about non-emergency medical transportation service, Medicaid service and a list of the providers that could provided that service, for the social workers. '}},
{ timecode: 1455, handler: 'blob', id: 101, data: {text: 'CHARLES: What you found perhaps was that some of the social workers weren’t aware of some resources that were available. PAT WEAVER: Right. Exactly. Exactly. CHARLES DICKSON: Is that something '}},
{ timecode: 1463, handler: 'blob', id: 102, data: {text: 'that you can talk to Michelle? MICHELLE HANSEN: Definitely. We found that well with our project, we are working very closely with some of the key treatment facilities in Sioux Falls. It was '}},
{ timecode: 1477, handler: 'blob', id: 103, data: {text: 'Shelly’s title, is she the director of the oncology clinic? She was actually part of our team, and so having such a high level official from the hospital who was engaged in this issue of block '}},
{ timecode: 1490, handler: 'blob', id: 104, data: {text: 'scheduling or to try to really even just tackle on a broader scope transportation issues of their patients and trying to some coordination really helpful. Then also having that access to all their '}},
{ timecode: 1502, handler: 'blob', id: 105, data: {text: 'social workers to try to train them get them used to referring to different services. It seems like a, form my perspective, social workers really like the word free and that is the quickest way to get '}},
{ timecode: 1518, handler: 'blob', id: 106, data: {text: 'them to start referring to a certain resource or service, and so, but again, even as training them and giving them the materials they need and increasing their familiarity with the types of options or '}},
{ timecode: 1533, handler: 'blob', id: 107, data: {text: 'the discussion that even should be had. A lot of times we will find that people’s conversations were not in transportation stops. It only gets to one point, can you help me with this state or '}},
{ timecode: 1545, handler: 'blob', id: 108, data: {text: 'this time. Then if you say no, then there’s no more discussion versus a dialog approach. And especially when you’re dealing with the idea that, and perhaps from the other perspective, can '}},
{ timecode: 1558, handler: 'blob', id: 109, data: {text: 'the hospital change the date of the appointment or time to better accommodate some of this. And so by involving the hospital from their directors we were able to try to address some of these barriers '}},
{ timecode: 1572, handler: 'blob', id: 110, data: {text: 'that might have prevented a patient for using another resource other than family or friends. CHARLES DICKSON: I mentioned team, and I know that Ron you talked a little bit about. Can you just talk a '}},
{ timecode: 1583, handler: 'blob', id: 111, data: {text: 'little bit about the Institute for Transportation Coordination that you guys attended last fall and sort of what the goal of the team was and what you guys did at that institute to help move this '}},
{ timecode: 1597, handler: 'blob', id: 112, data: {text: 'project forward. Go ahead Ron. RON BAUMGART: Okay. Well, I think Michelle really lead the charge on getting our team nominated to get there but certainly from our relationship with ACS prior grant and '}},
{ timecode: 1617, handler: 'blob', id: 113, data: {text: 'working with providing that care to treatment centers, we realized there was a real need too. I think, Michelle really addressed it, and you did as well. Everybody thinks that transportation '}},
{ timecode: 1630, handler: 'blob', id: 114, data: {text: 'isn’t an issue, but you need to ask maybe more than just one question or two questions to find out if it is an issue. What we’ve learned in the ones we have provided service for, it may be '}},
{ timecode: 1641, handler: 'blob', id: 115, data: {text: 'an older adult that have kids, say my age, that have spent days at a treatment center diagnosing what this individual has, they are still both employed, they work, they have used up about all of their '}},
{ timecode: 1655, handler: 'blob', id: 116, data: {text: 'sick leave and now they’re facing 3 to 4 to 5 weeks that their mom or dad gets to go to treatment, The first question to that person that is actually getting the treatment might be do you have '}},
{ timecode: 1666, handler: 'blob', id: 117, data: {text: 'problems with transportation, no. But there really is a problem because these folks are now going to miss their jobs and so the ones that we have provided service to this has been a big help to family '}},
{ timecode: 1677, handler: 'blob', id: 118, data: {text: 'members and others that are freed up to keep their job going, keep their income and in some cases keep the husband working while the wife’s going daily with us to treatment to Sioux Falls or '}},
{ timecode: 1691, handler: 'blob', id: 119, data: {text: 'Mitchell. I guess the last thing what we look for and what I think we tried to focus on as our team is how do we take—if you have cancer or if you’ve got any other—we are ride '}},
{ timecode: 1705, handler: 'blob', id: 120, data: {text: 'specific just to cancer treatments, any health condition. The last thing you want to worry about is how am I going to get there to get the best treatment you can get. Also as a smaller community and '}},
{ timecode: 1716, handler: 'blob', id: 121, data: {text: 'as a past politician too in my past life, we don’t want to lose our people in our small communities, and we will lose them if we don’t provide them the best possible medical care that they '}},
{ timecode: 1726, handler: 'blob', id: 122, data: {text: 'can get, and how we do that then is successful treatment centers, heart hospitals and then bring those folks back to our community where we like them to stay. MICHELLE HANSEN: I think what the '}},
{ timecode: 1737, handler: 'blob', id: 123, data: {text: 'institute really helped us do was sort of take a broader community mobilization of our transportation effort that we had been looking at and really focus it in on a specific project that we can tackle '}},
{ timecode: 1748, handler: 'blob', id: 124, data: {text: 'and try to implement to make a difference, and so it was sort of like that first pillar in the step and it was really helpful in just sort of, I guess, launching our coordination effort. CHARLES '}},
{ timecode: 1761, handler: 'blob', id: 125, data: {text: 'DICKSON: And have you been able to keep that team together since the institute? MICHELLE HANSEN: Oh, yes. Our team meets monthly right now and of course we also continue to meet or have private '}},
{ timecode: 1770, handler: 'blob', id: 126, data: {text: 'conversations but always bring the results back to the team, and how we are developing continued outreach trying to bring more transit providers in to participate helping our health care providers '}},
{ timecode: 1783, handler: 'blob', id: 127, data: {text: 'work with the service. There’s sometimes some competition in the health care industry that’s a completely different from what you might experience in some other industries too, '}},
{ timecode: 1796, handler: 'blob', id: 128, data: {text: 'there’s competition there. We are helping them team up together as well. Not that they are not willing to team up. They just want to be at first. RON BAUMGART: They want a third day instead of '}},
{ timecode: 1807, handler: 'blob', id: 129, data: {text: 'the one the other clinics wants. So. CHARLES DICKSON: All right. I think you have a question here for one of our panelist. AUDIENCE MEMBER: First I have a question for the woman from ACS and then the '}},
{ timecode: 1824, handler: 'blob', id: 130, data: {text: 'professor I would like to ask you a question. From ACS he mentioned that he received a grant from ACS for transportation whereas the other person didn’t mention receiving a grant from ACS. How '}},
{ timecode: 1840, handler: 'blob', id: 131, data: {text: 'do you determine which way you are going to put your resources as far as the grants you give out to providers? MICHELLE HANSEN: Well, that’s a great question. Transportation grants have been '}},
{ timecode: 1850, handler: 'blob', id: 132, data: {text: 'sort of one path the ACS has used to try to influence change or to address different community needs. There’s an application process and review panel. Transportation grants, however, have not '}},
{ timecode: 1864, handler: 'blob', id: 133, data: {text: '– there’s something that depends on if we have receive a large donation to address transportation, that would be the opportunity to apply some grants. There have been some other forms of '}},
{ timecode: 1876, handler: 'blob', id: 134, data: {text: 'transportation assistance that we also supply. We also have whether it is assistance or transportation assistance. It really depends. Currently we don’t have any direct transportation grants '}},
{ timecode: 1890, handler: 'blob', id: 135, data: {text: 'right now in our division but again each division is different it really depends on sometimes donations. AUDIENCE MEMBER: Professor, I have a question for you. I believe that most dialysis centers are '}},
{ timecode: 1905, handler: 'blob', id: 136, data: {text: 'privately owned, they’re not public, so are they kicking anything in? PAT WEAVER: Generally not. I think that as far as the Medicaid transportation, you know, about 30 percent or so of the folks '}},
{ timecode: 1927, handler: 'blob', id: 137, data: {text: 'in Kansas, of the 2500 or so who are accessing dialysis treatment are eligible for Medicaid, but as far as I know, there is not money from the clinics for transportation. AUDIENCE MEMBER: I think you '}},
{ timecode: 1944, handler: 'blob', id: 138, data: {text: 'should try and get to the boards of these organizations of the companies and tell them—you know give them the statistics about how somebody in your family—that it is a high percentage rate '}},
{ timecode: 1956, handler: 'blob', id: 139, data: {text: 'that someone in your family is going to develop a disability along the line and wouldn’t you want to make sure that they were able to get the services they need and since you are a corporation, '}},
{ timecode: 1966, handler: 'blob', id: 140, data: {text: 'your office is for profit, I think, doing a specific duty you should make contributions towards transportation. PAT WEAVER: I think that, I think though the forum of Wichita was a good example of that '}},
{ timecode: 1982, handler: 'blob', id: 141, data: {text: 'dialog developing with those corporations and kind of where that goes remains to be seen. Another element of that, that came out of that, was recognition that there is a little bit of emergency '}},
{ timecode: 1998, handler: 'blob', id: 142, data: {text: 'funding that’s available to individuals it is often used for transportation that they can access the Kansas Dialysis Association or Kansas Kidney Association was willing—they were '}},
{ timecode: 2020, handler: 'blob', id: 143, data: {text: 'participated in the session as far as being willing to be a fiscal agent if some additional funding could be identified for that emergency funding to assist people when they need some additional '}},
{ timecode: 2032, handler: 'blob', id: 144, data: {text: 'funding for transportation. AUDIENCE MEMBER: (in audible). PAT WEAVER: One of the other thing, Charlie you asked the question about the efforts that are developing and kind of from the statewide '}},
{ timecode: 2049, handler: 'blob', id: 145, data: {text: 'level, in Kansas we have had coordinated transit districts for a long time but they have been primarily more kind of the administrative districts, you know, in terms of coordination. Last year, then '}},
{ timecode: 2067, handler: 'blob', id: 146, data: {text: 'Governor Kathleen Sebelius now Secretary Sebelius convened a Governor’s task force on transportation really having to do with the continued funding transportation in the state. We’ve had, '}},
{ timecode: 2084, handler: 'blob', id: 147, data: {text: 'over the past 20 years, we’ve had good support from the Legislature and then the last transportation bill that was authorized 10 years ago included this multimillion dollar and it included '}},
{ timecode: 2097, handler: 'blob', id: 148, data: {text: 'funding for transit. That emphasis continues, but is running out this year, so she convened a task force. One of the recommendations that came out of that on the transit side was to move to more '}},
{ timecode: 2113, handler: 'blob', id: 149, data: {text: 'regionalization of transit services which would include support for mobility management as well as the technology in terms of computerized scheduling and dispatch. To address that issue in terms of '}},
{ timecode: 2131, handler: 'blob', id: 150, data: {text: 'the local match that leads us to kind of county based services and makes it difficult to address the long distance medical transportation needs. Statewide there are some things that, you know some '}},
{ timecode: 2146, handler: 'blob', id: 151, data: {text: 'recommendations that have come out of that and some things that are happening to move us in that direction. CHARLES DICKSON: Another question. AUDIENCE MEMBER: This is for Michelle and Ron. I was '}},
{ timecode: 2157, handler: 'blob', id: 152, data: {text: 'curious if you had looked at sliding fee scales and things. We find that we have that group that are Medicaid eligible and then those that can’t afford much, and those that really can afford '}},
{ timecode: 2168, handler: 'blob', id: 153, data: {text: 'transportation but still need to have it. Did you look at that as an option? MICHELLE HANSEN: With the sliding fee scale, with our project as we started out. We wanted to get people sort of like a '}},
{ timecode: 2181, handler: 'blob', id: 154, data: {text: 'base sense of what the fee would cost and try to reduce that. I think right now a sliding fee scale is more of a don’t ask, don’t tell. Or is it a little bit more… RON BAUMGART: '}},
{ timecode: 2196, handler: 'blob', id: 155, data: {text: 'We’re working on that. I mean some of this is just you know, this is something we’ve just started as a team basically what there hoping that sometime we can make this statewide. We have '}},
{ timecode: 2208, handler: 'blob', id: 156, data: {text: 'eleven transit agencies. You were just talking about with technology there’s some things we can do. We have eleven transit agencies in South Dakota that are on the same software dispatch systems '}},
{ timecode: 2220, handler: 'blob', id: 157, data: {text: 'by choice, not forced. New version will allow us to put rides out there that basically—you know if there is a medical ride the next few days, why it is out there for all transit providers to see '}},
{ timecode: 2234, handler: 'blob', id: 158, data: {text: 'you and possibly even a provider from the east of us is going to the west, they can come through and pick up our individual as well. So we hope to go bigger, more full scale with this, but our concern '}},
{ timecode: 2246, handler: 'blob', id: 159, data: {text: 'with trying something that big is that we would fail or it would be unreliable and so we started fairly small and want to build off of that. AUDIENCE MEMBER: I have a general question on '}},
{ timecode: 2263, handler: 'blob', id: 160, data: {text: 'transportation related to hospitals. What have you seen, if any, of the best practices out there for hospitals? They tend to be the demand generators for transportation, but they also encompass a fair '}},
{ timecode: 2276, handler: 'blob', id: 161, data: {text: 'amount of private pay business that would help subsidize a transportation network that seems best served under a fixed route given the elements of time associated with health care service. A person '}},
{ timecode: 2290, handler: 'blob', id: 162, data: {text: 'goes in for dialysis and if they bleed out they take a lot more time, chemotherapy can go on for 2 hours, 3 hours, so it’s hard to predict that with a call back system on an on demand system. So '}},
{ timecode: 2302, handler: 'blob', id: 163, data: {text: 'I am curious whether you seen best practices with hospitals because they tend to be the demand generators. MICHELLE HANSEN: I think that would be a great report to have a comparison of what hospitals '}},
{ timecode: 2313, handler: 'blob', id: 164, data: {text: 'do with transportation and then really try to cull from that the best practices. From my experience in the Midwest division, which is 4 states, South Dakota, Wisconsin, Iowa, and Minnesota, we have a '}},
{ timecode: 2327, handler: 'blob', id: 165, data: {text: 'wide range of involvement that a hospital will sort of participate in as it relates to transportation. For some of those hospitals, there is a very generous type of policy. For others, it’s '}},
{ timecode: 2341, handler: 'blob', id: 166, data: {text: 'nonexistent. And for some, they try to really use maybe lodging as a solution for some of these transportation situations, which is another thing that American Cancer Society looks to when you are '}},
{ timecode: 2354, handler: 'blob', id: 167, data: {text: 'dealing someone going very long distances but has a daily regimen of treatment that they have to take care of. So it is my experience that it is very across the board, but it certainly ever a '}},
{ timecode: 2366, handler: 'blob', id: 168, data: {text: 'complete—the most they have run maybe a shuttle service or an extended shuttle service within the city. It would not necessarily get to the point where they are doing long distance. Unless they '}},
{ timecode: 2376, handler: 'blob', id: 169, data: {text: 'were able to do a voucher reimbursement program. RON BAUMGART: Can I just add that you need to stick around for the session that’s following this one, because that is going to be an entire '}},
{ timecode: 2388, handler: 'blob', id: 170, data: {text: 'session that focuses particularly on that question. We’re going to talk about health centers that not only as destinations, but as trip generators and the fact that they are large employment '}},
{ timecode: 2402, handler: 'blob', id: 171, data: {text: 'centers as well which also require a lot of transportation. DAVID WHITE: I would just make one comment on that on this question is that generally when we are talking about dialysis and chemo and those '}},
{ timecode: 2414, handler: 'blob', id: 172, data: {text: 'kinds of treatments. Folks who are not in real good shape to be utilizing fixed route when they are done with those treatments. You are probably looking for some other kind of—if they are in '}},
{ timecode: 2429, handler: 'blob', id: 173, data: {text: 'need of some kind of assisted transportation, they are usually in need of some other kind of transportation other than fixed route. Most of the time I am thinking. PAT WEAVER: And we have some '}},
{ timecode: 2441, handler: 'blob', id: 174, data: {text: 'experience in our state with some of the regional health centers providing funding that met the local match. The difficulty that we’ve seen is that it hasn’t sustained. They will provide '}},
{ timecode: 2457, handler: 'blob', id: 175, data: {text: 'it and then for a variety of reasons that maybe a change in management or maybe just the particular fiscal realities that that will discontinue. We’ve had some services that has started in that '}},
{ timecode: 2471, handler: 'blob', id: 176, data: {text: 'way but has not sustained over time. In another instance, one agency was actually—had been contracting for—one hospital had been contracting for the service but there were two hospitals in '}},
{ timecode: 2485, handler: 'blob', id: 177, data: {text: 'the area and they were obviously in competition, so they began providing their own service and provided service in a fairly wide area to the individuals coming to their facility. But that service is '}},
{ timecode: 2503, handler: 'blob', id: 178, data: {text: 'not in place anymore either. I don’t classify those in best practices. I think having the regional health centers as partners, financial partners was certainly—was very helpful and kept '}},
{ timecode: 2521, handler: 'blob', id: 179, data: {text: 'that service going for a few years but it has not sustained. DAVID WHITE: If I could Charlie, let me ask Pat a follow up. With dialysis for folks not on Medicaid, older elderly folks, are you '}},
{ timecode: 2541, handler: 'blob', id: 180, data: {text: 'finding—that are on Medicare. Did you find in your research that ambulances are being used for that transportation? PAT WEAVER: Ambulances weren’t identified in that way. But generally it '}},
{ timecode: 2556, handler: 'blob', id: 181, data: {text: 'was—if you looked, there is definitely if you look at the results of the questions from the more urbanized areas and I use that term loosely there. Small urban communities I guess. You know '}},
{ timecode: 2571, handler: 'blob', id: 182, data: {text: 'there was more examples of people using Para transit type services to get to their service. But in the more rural areas it was almost. AUDIENCE MEMBER: We can’t hear you back here. PAT WEAVER: '}},
{ timecode: 2585, handler: 'blob', id: 183, data: {text: 'Sorry. That better? But in the rural areas and looking at those Reponses it was almost exclusively family and friends. We do have some rural transit providers that do provide dialysis treatment, but '}},
{ timecode: 2603, handler: 'blob', id: 184, data: {text: 'it is, matching that up to the sample who responded in the survey that number was very low. AUDIENCE MEMBER: I’m sorry if you’ve addressed this already. I want to ask the question about '}},
{ timecode: 2623, handler: 'blob', id: 185, data: {text: 'bundling appointments for dialysis. I am from New Hampshire and our dialysis centers, appointments are usually done, I’ll say on a pecking order by seniority. The longer you’ve been at the '}},
{ timecode: 2634, handler: 'blob', id: 186, data: {text: 'dialysis center, the more choice you have on when your appointment—when you can go in because you have to block out like a 3 hour amount of your time. Have you been able to work with dialysis '}},
{ timecode: 2646, handler: 'blob', id: 187, data: {text: 'centers and how successful have you been in bundling those appointments for clients that may not have enough seniority to decide when their appointments are going to be. PAT WEAVER: We had some '}},
{ timecode: 2658, handler: 'blob', id: 188, data: {text: 'indication from some of the transit providers that they had a good collaborative relationship with their clinics in that they had worked with those individuals and with the clinic and the individuals '}},
{ timecode: 2672, handler: 'blob', id: 189, data: {text: 'there to coordinate some trips. If you look at how disperse they are, particularly in the western half of the state, how dispersed those individuals are, it’s even hard to bundle those because '}},
{ timecode: 2690, handler: 'blob', id: 190, data: {text: 'the distances between those 2 patients or 3 or 4 patients may be very great, and then on to the clinic. Then some of the comments then from the—that we receive from the social workers in the '}},
{ timecode: 2704, handler: 'blob', id: 191, data: {text: 'interviews was a lot of concern about wait times at the end, you know, because of people generally in a little more weakened condition after a dialysis and that, you know, an hour or two hour wait at '}},
{ timecode: 2720, handler: 'blob', id: 192, data: {text: 'the end, you know if there was some discrepancy in terms of the schedules that there was a lot of difficulty with that. That really was not a good solution. But when your talking about very long '}},
{ timecode: 2734, handler: 'blob', id: 193, data: {text: 'distances it is often hard to avoid those kinds of discrepancies in schedules. CHARLES DICKSON: Ron and Michelle do you want to weight in on that and talk about the experiences you’ve had trying '}},
{ timecode: 2748, handler: 'blob', id: 194, data: {text: 'to bundle these trips. RON BAUMGART: It is starting to work; I guess I would put it that way. And I mean it is basically because health care providers are finally seeing some value in what we’re '}},
{ timecode: 2760, handler: 'blob', id: 195, data: {text: 'doing I think, and so they’re working with us and trying to–-because where we’re going is about a 3 to 3½ hour trip each way. If we can get a time window of like 11 o\'clock in the '}},
{ timecode: 2771, handler: 'blob', id: 196, data: {text: 'morning to 3:00 in the afternoon so we can get these folks home on a decent time and not have the driver out 12 to 14 hours too. We are seeing success in that. Yes. MICHELLE HANSEN: You know, some of '}},
{ timecode: 2783, handler: 'blob', id: 197, data: {text: 'the things about the limitations or the constraints that we have on the distance that we’re traveling it gives us fewer options, and so, you know, you have to go with a longer all-day trip '}},
{ timecode: 2795, handler: 'blob', id: 198, data: {text: 'experience, and obviously that’s not going to work for everyone, which is why lodging then for us starts to become an important role in the whole solution. AUDIENCE MEMBER: I had a question and '}},
{ timecode: 2807, handler: 'blob', id: 199, data: {text: 'that is in your dealing with both the dialysis clinics and the hospitals, who is it that you contacted at those facilities to start getting this to work? What level? What were the titles of people? '}},
{ timecode: 2826, handler: 'blob', id: 200, data: {text: 'Were they the social workers? Were they the business offices? Who were they that you contacted, so if somebody is wanting to replicate this to do it in their area, who would they, who would they be '}},
{ timecode: 2840, handler: 'blob', id: 201, data: {text: 'contacting? MICHELLE HANSEN: Well, for us, the American Cancer Society. There is a lot of large study groups or a lot of other support groups where we have contacts in the health care field, so '}},
{ timecode: 2853, handler: 'blob', id: 202, data: {text: 'Comp-Cancer is what it\'s called in South Dakota, it\'s a very large group they do surveys. They really reach out into the community, and they\'ve done a lot of our surveys, and'}},
{ timecode: 2864, handler: 'blob', id: 203, data: {text: 'were able to look a little bit to them to try to identify some of our key relationship contacts. But the American Cancer Society also has the benefit of having at least one staff person assigned to '}},
{ timecode: 2875, handler: 'blob', id: 204, data: {text: 'every, we call them, Commission on Cancer Treatment Facilities and so we’re able to typically have a couple of key contacts already identified in those facilities. And then hopefully we train '}},
{ timecode: 2887, handler: 'blob', id: 205, data: {text: 'the social workers very well to refer cancer patients to us. PAT WEAVER: Then the dialysis clinics it was definitely social workers. Often those social workers staff more than one clinic, so they may '}},
{ timecode: 2900, handler: 'blob', id: 206, data: {text: 'have 2 or 3 clinics in the maybe immediate area or maybe much further distance, but that was basically the administrative staff for those clinics and they indicated to us that they were in all '}},
{ timecode: 2918, handler: 'blob', id: 207, data: {text: 'instances they were the best contact. Generally, in making the contact even for doing the survey, the social workers were saying yes, this is really an important issue. In a couple of instances, '}},
{ timecode: 2933, handler: 'blob', id: 208, data: {text: 'unfortunately, their corporate offices said no surveys. For a variety of reasons, we don’t want to inconvenience the patients to no explanation really. Really the social workers in all cases '}},
{ timecode: 2952, handler: 'blob', id: 209, data: {text: 'were really tremendous to work with and I know in the Wichita example that they participated very intensively in the ongoing meetings that are going on and really have expressed a lot of benefit out '}},
{ timecode: 2969, handler: 'blob', id: 210, data: {text: 'of that experience. AUDIENCE MEMBER: Well, you came up on a topic I would like to ask you about what you think. I often think about the fact after the history we went over this morning and what we '}},
{ timecode: 2982, handler: 'blob', id: 211, data: {text: 'know of this aging population what the challenge is now. Isn’t it going to be imperative that we actually go to corporate headquarters for these companies? My impression is many hospitals are '}},
{ timecode: 2992, handler: 'blob', id: 212, data: {text: 'chains, maybe dialysis centers are too, I am not familiar enough to know with the industry. But, you know, if people are familiar with the industry doesn’t it seem like we need to have really '}},
{ timecode: 3002, handler: 'blob', id: 213, data: {text: 'big policy changes at corporate headquarters so that everywhere there is a Providence type hospital they are committed to now working with transportation or something like this. It just seems like '}},
{ timecode: 3015, handler: 'blob', id: 214, data: {text: 'that kind of scales what is called for. I would like to hear your comments. PAT WEAVER: My comment is that there is little “C” coordination and there’s big “C” '}},
{ timecode: 3025, handler: 'blob', id: 215, data: {text: 'coordination, and you’re talking about the big “C” and so there’s, you know, there are partnerships and collaborations that always will have to happen at that local level even '}},
{ timecode: 3036, handler: 'blob', id: 216, data: {text: 'if you have a policy from the corporate—when it gets translated you still have to have that. But you’re absolutely right that, you know, making these kinds of fundamental changes in how we '}},
{ timecode: 3047, handler: 'blob', id: 217, data: {text: 'do business is going to have to happen at that level in the big “C” coordination. AUDIENCE MEMBER: Yes. In your survey did you see many dialysis centers actively encouraging assisting '}},
{ timecode: 3066, handler: 'blob', id: 218, data: {text: 'people to have home dialysis? PAT WEAVER: Actually, yes. We didn’t, we didn’t include home dialysis in this project. You know, we started out really trying to keep it a fairly small scale '}},
{ timecode: 3082, handler: 'blob', id: 219, data: {text: 'and it kept getting bigger and bigger. But home dialysis is an issue that in talking with the social workers, in some cases for those individuals the transportation issue is even greater although not '}},
{ timecode: 3097, handler: 'blob', id: 220, data: {text: 'ongoing but the trips to the specialists is a longer distance. We only have those services in three cities in the state, and so a lot of it’s not as frequent, it’s still requires some very '}},
{ timecode: 3114, handler: 'blob', id: 221, data: {text: 'long distance of transportation, and that presents a challenge as well. So on the one hand, it may solve the weekly issue of transportation, but we still do have that that long distance medical trip '}},
{ timecode: 3130, handler: 'blob', id: 222, data: {text: 'involved in it as well. AUDIENCE MEMBER: True but if you aren’t going three days a week and you’re going once or twice a month it does take care of some of the transportation itself. PAT '}},
{ timecode: 3143, handler: 'blob', id: 223, data: {text: 'WEAVER: I’m not a specialist on dialysis treatment, but I understood that there are decisions that have to be made between the two types of treatment and that you can’t necessarily decide '}},
{ timecode: 3158, handler: 'blob', id: 224, data: {text: 'on that but like I say I’m not an expert on that, on that question at all, but it certainly makes sense, and also, you know, the other part of it in terms of making—looking at options for '}},
{ timecode: 3175, handler: 'blob', id: 225, data: {text: 'bringing those specialists to communities, you know, grouping, blocking those trips. The less frequent kinds of service that might be needed as far as looking at more remote medical treatment options '}},
{ timecode: 3190, handler: 'blob', id: 226, data: {text: 'in that way. AUDIENCE MEMBER: Also you might want to point out to these health facilities because even though it is costing them money they don’t realize it because it’s not recorded, but '}},
{ timecode: 3203, handler: 'blob', id: 227, data: {text: 'how much money they lose when people cancel trips or they miss an appointment or late for an appointment. Those things cost a lot of money, but they don’t document down as a cost, so if you '}},
{ timecode: 3215, handler: 'blob', id: 228, data: {text: 'point out to them that you’re actually saving them money by allowing you to bundle the trips, I think that they will realize that it is to their advantage. MICHELLE HANSEN: You know, I think '}},
{ timecode: 3226, handler: 'blob', id: 229, data: {text: 'that’s been something that we’ve seen more and more of in terms of wanting to help people keep their medical appointments, not to cancel last minute. One of the things in South Dakota that '}},
{ timecode: 3237, handler: 'blob', id: 230, data: {text: 'has come out that has sort of changed some peoples perspectives was the number of women who are more willing to get double mastectomies that to have to commit to consistent treatment. That’s '}},
{ timecode: 3250, handler: 'blob', id: 231, data: {text: 'really been certainly a clear picture, just the increase of that, that really sort of helped explained to everyone the challenges of committing to Monday through Friday for 4 to 6 weeks, and that they '}},
{ timecode: 3264, handler: 'blob', id: 232, data: {text: 'felt it was easier on them and on their family, and it’s just a different, it just seemed like the better choice for a lot of women, which was very surprising. Now that being said as a dramatic '}},
{ timecode: 3277, handler: 'blob', id: 233, data: {text: 'illustration. I will say that the whole community mobilization approach, where you do reach out to a health group to come in to be apart of the solutions has been very helpful because it’s so '}},
{ timecode: 3290, handler: 'blob', id: 234, data: {text: 'easy to point and I’m sure you guys have all received this – solve the problem. What are you going to do for me? You know, why isn’t it, why don’t you have free sustainable '}},
{ timecode: 3300, handler: 'blob', id: 235, data: {text: 'transportation? It has been nice with community mobilization to bring them in and have them have a place at the table and help to create solutions, which hopefully, they’ll also invest in. '}},
{ timecode: 3314, handler: 'blob', id: 236, data: {text: 'AUDIENCE MEMBER: You are dealing with really targeted groups that need regular treatment. What about somebody who may have need some specialized testing or surgery or something along those lines, and '}},
{ timecode: 3329, handler: 'blob', id: 237, data: {text: 'this may be the wrong panel to ask it may be the next one. My second question too is for Ron, is how full are your vehicles and is it available to other people on a space available basis? RON '}},
{ timecode: 3340, handler: 'blob', id: 238, data: {text: 'BAUMGART: We do track – like I said, we don’t just provide medical transportation for cancer treatment. We provide it for anybody that requests it. It was just, this is a way to get us '}},
{ timecode: 3353, handler: 'blob', id: 239, data: {text: 'something started that we can focus on a couple of days a week that we go to certain communities, and certainly if we need to grow past the minivan or past the 15 passenger van, we’ll do that. I '}},
{ timecode: 3366, handler: 'blob', id: 240, data: {text: 'mean, that’s really what we want to do. Quite frankly, I’d like to see that we actually run five days a week to these communities, so if a same day surgery doesn’t end up being a '}},
{ timecode: 3376, handler: 'blob', id: 241, data: {text: 'same day surgery, there is a ride back the next day and things. I guess that is one of the things the more we can develop the more we can open this up, it doesn’t cost me a whole lot more to run '}},
{ timecode: 3386, handler: 'blob', id: 242, data: {text: 'that vehicle out there full than with one or two people on it. So we’re looking at every avenue. We’re trying to educate the health care professionals and hospitals and things; but quite '}},
{ timecode: 3395, handler: 'blob', id: 243, data: {text: 'frankly they have something to offer them and they can sort of notice the difference. It is really hard to sell what you’re saving them. We sure found that in our area. They really don’t '}},
{ timecode: 3404, handler: 'blob', id: 244, data: {text: 'pay a lot of attention to us. I think there has been a little bit of change lately because of our local clinics have pretty much been bought out by the two big major hospitals in the state so now they '}},
{ timecode: 3414, handler: 'blob', id: 245, data: {text: 'are seeing the value of being able to refer these people from their clinics to the major medical centers. We are starting to make some headway there. Our trips are certainly open to anyone that needs '}},
{ timecode: 3427, handler: 'blob', id: 246, data: {text: 'any kind of treatment. We just love to have partners like the American Cancer Society to help us with those in any way that they might be able to. Even if it is just partially coordination. If '}},
{ timecode: 3437, handler: 'blob', id: 247, data: {text: 'it’s education, getting the public to realize it’s there, and also I think when you asked the question about social workers, to teach them to ask more than just that one question “is '}},
{ timecode: 3449, handler: 'blob', id: 248, data: {text: 'transportation an issue” because for some it may not be but to the people furnishing the transportation for that individual it may be quite a problem if it’s for five days a week for the '}},
{ timecode: 3461, handler: 'blob', id: 249, data: {text: 'next five weeks or something. We have done those kinds of trips for individuals for five weeks of radiation five days a week. MICHELLE HANSEN: How are you going to get to treatment? How have you been '}},
{ timecode: 3471, handler: 'blob', id: 250, data: {text: 'getting to treatment? Are they always helping you? Just to continue to have a couple of different wave of options to do a real transportation assessment. Not that those are the best questions in the '}},
{ timecode: 3485, handler: 'blob', id: 251, data: {text: 'world but. It is just starting a dialog. CHARLES DICKSON: Ron, I have a question for you. We’ve talked a lot about the coordination in working with the American Cancer Society. Can you just talk '}},
{ timecode: 3499, handler: 'blob', id: 252, data: {text: 'generally? I know they’ve done a lot of work just within your area on coordinating services since you’ve taken over. What were some of the challenges you faced there, and then when you try '}},
{ timecode: 3511, handler: 'blob', id: 253, data: {text: 'and go to providing almost a statewide transportation network, what are the challenges you face in coordinating those services with other providers? RON BAUMGART: I don’t think I have enough '}},
{ timecode: 3524, handler: 'blob', id: 254, data: {text: 'time. Quite frankly, as I said earlier, transit or public transit in a very rural area some of you know is work. Our corporation, nonprofit corporation is only 10 years old. I was hired in 2001 to be '}},
{ timecode: 3541, handler: 'blob', id: 255, data: {text: 'the director, so that’s a pretty short span to have a public transit, and quite frankly, most people weren’t even aware that they had one in their community or if they did they thought it '}},
{ timecode: 3553, handler: 'blob', id: 256, data: {text: 'was a senior bus or something like that, so in our years of—really need to be out there and you need to a good job of whatever you do so that if you start your coordination process and you start '}},
{ timecode: 3567, handler: 'blob', id: 257, data: {text: 'providing service for adjustment training centers or you provide Head Start transportation and you need to do the best job you can do. We have just gained a lot through coordination. We basically '}},
{ timecode: 3581, handler: 'blob', id: 258, data: {text: 'provide all the transportation in central South Dakota now for just about—we are open 24 hours a day, 7 days a week, for any kind of transportation that you need. CHARLES DICKSON: Can you repeat '}},
{ timecode: 3594, handler: 'blob', id: 259, data: {text: 'that I’m not sure if everybody heard that. That’s very unusual for a rural area. RON BAUMGART: Our community has no taxi or any other type of transportation. We are open 24 hours a day, 7 '}},
{ timecode: 3604, handler: 'blob', id: 260, data: {text: 'days a week. Never close. Demand response or a prescheduled basis. We also, like I said earlier, there is several other—as we did this statewide coordination effort going with our software and '}},
{ timecode: 3619, handler: 'blob', id: 261, data: {text: 'logistical routing things that we have all put together, eleven agencies throughout the state. We will be able to put those rides out there that are in Huron South Dakota, Mitchell South Dakota, '}},
{ timecode: 3629, handler: 'blob', id: 262, data: {text: 'Pierre or whatever. And all the directors or all the dispatchers would be able to see those rides to where if we are going through a community, we can serve that community as well as our community and '}},
{ timecode: 3638, handler: 'blob', id: 263, data: {text: 'not take 3 minivans to Sioux Falls on the same exact day and have them park next to each other while we are waiting for people. You know, you only do it one step at a time and make sure that you do a '}},
{ timecode: 3649, handler: 'blob', id: 264, data: {text: 'good job of it. Again, many of the people that ride with us, this is the very first time they’ve ever used any kind of public transit. They are afraid you might forget them in town of Sioux '}},
{ timecode: 3658, handler: 'blob', id: 265, data: {text: 'Falls. The family members are afraid, what is the driver like and things like that. So that’s the challenge of doing that in a real rural area. CHARLES DICKSON: You have a question back here? '}},
{ timecode: 3677, handler: 'blob', id: 266, data: {text: 'AUDIENCE MEMBER: I would just like to follow up on what Ron’s saying. I’m from a rural county in upstate New York. VOICE: Talk straight into the mike. Straight into it. There you go. '}},
{ timecode: 3695, handler: 'blob', id: 267, data: {text: 'AUDIENCE MEMBER: I’m from a rural county in upstate New York, and we run a 5-day a week demand response, but the key, and at least, one of the problems with our dialysis centers is they’re '}},
{ timecode: 3712, handler: 'blob', id: 268, data: {text: 'located in one portion of our county. Mostly the northeast. We’re bringing people from the rural areas, so the ride itself can be anywhere from an hour to an hour and a half. And then by the '}},
{ timecode: 3724, handler: 'blob', id: 269, data: {text: 'time they’ve had their treatment, which is 3, 3½ to 4 hours, and then the trip back. What I’m getting at is even though someone may say can you fill the vehicle, you can’t do that '}},
{ timecode: 3737, handler: 'blob', id: 270, data: {text: 'because you have to think of what each and every individual has to go through. So yes you can pick up other people on the way for other purposes, but I think transportation providers are always '}},
{ timecode: 3750, handler: 'blob', id: 271, data: {text: 'keeping in mind the condition of those clients after their treatment, so I just, you know, I can empathize with where you’re at Ron. CHARLES DICKSON: Where there any other questions right now? '}},
{ timecode: 3769, handler: 'blob', id: 272, data: {text: 'AUDIENCE MEMBER: As you work to coordinate with the medical providers, did anyone mention or suggest that bundling appointments actually might be an issue with patient confidentiality? Because that '}},
{ timecode: 3782, handler: 'blob', id: 273, data: {text: 'actually is the barrier we get from our Medicaid broker that they can’t share trips because it’s somehow a violation of HIPAA. MICHELLE HANSEN: Well essentially what were doing is '}},
{ timecode: 3792, handler: 'blob', id: 274, data: {text: 'we’re trying to sell an all day trip, I guess is what you could say. And we’re doing it for such long distances that—we are doing it for such long distances that it essentially we '}},
{ timecode: 3806, handler: 'blob', id: 275, data: {text: ' are selling people the trip and the health care providers referring people to the actual service. DAVE WHITE: I will make a comment on that. Valerie let me comment on that. What you - because my'}},
{ timecode: 3825, handler: 'blob', id: 276, data: {text: 'organization is a Medicaid broker. There are some funding sources will put some constraints on bundling or mixing clients. But I have actually never heard anybody use HIPAA as a reason. Call it the'}},
{ timecode: 3849, handler: 'blob', id: 277, data: {text: 'HIPAA what? AUDIENCE MEMBER: Play the HIPAA card. DAVE WHITE: Here’s the response, is I think there are reasons not to intermingle clients because of behavioral health issues or adults with'}},
{ timecode: 3867, handler: 'blob', id: 278, data: {text: 'children or those kinds of issues. But I have – I cannot find, and I don’t pretend to be a HIPAA expert, but I cannot–-and actually a broker is a business associate, they are not a '}},
{ timecode: 3889, handler: 'blob', id: 279, data: {text: 'covered entity so they’re liability under HIPAA is a lot less than a covered entity but the response would be is basically who are the clients on the vehicle and what are the issues with those '}},
{ timecode: 3908, handler: 'blob', id: 280, data: {text: 'individual clients. There may be some very good reasons not to intermingle clients, but I haven’t heart HIPAA being one of them. RON BAUMGART: Dave I will have to say, one of the things that we '}},
{ timecode: 3921, handler: 'blob', id: 281, data: {text: 'do at the Community Transportation Association is that we have an information station with an 800 number, and that is one of the questions that we’ve received over the years. Not only mixing '}},
{ timecode: 3934, handler: 'blob', id: 282, data: {text: 'clients, but we’ve actually had transportation providers who’ve been told they can’t put a bus stop by a medical center because that would then be violating patients DAVE WHITE: '}},
{ timecode: 3946, handler: 'blob', id: 283, data: {text: 'HIPAA too? Okay. RON BAUMGART: We actually, Ginger Ammon one of the first jobs she took on when she came over and worked on the information station was researching all of these HIPAA questions and the'}},
{ timecode: 3962, handler: 'blob', id: 284, data: {text: 'Department of Health and Human Services has even stated that HIPAA was never intended to limit anybody’s access to medical care. DAVE WHITE: That’s right. RON BAUMGART: Transportation is '}},
{ timecode: 3974, handler: 'blob', id: 285, data: {text: 'definitely an access issue, and there is absolutely nothing in the HIPAA regulation that would limit somebody’s access. And as Dave pointed out, is you’re a Medicaid broker or Medicaid '}},
{ timecode: 3987, handler: 'blob', id: 286, data: {text: 'provider, there might be some recordkeeping issues that would come into play and the safeguarding of records but certainly not place clients on vehicles. AUDIENCE MEMBER: Could I even comment? We hear '}},
{ timecode: 4002, handler: 'blob', id: 287, data: {text: 'this all the time from our DOT office, oh we can’t possibly drop them off there, everybody will know, it will violate their HIPAA rights etc. etc. Doesn’t it seem to me that if the client'}},
{ timecode: 4014, handler: 'blob', id: 288, data: {text: 'in the beginning is willingly taking this ride and is part of the process of giving consent? I mean, you’re not going to reveal their medical condition, but if they’re aware I don’t '}},
{ timecode: 4026, handler: 'blob', id: 289, data: {text: 'see how this could violate HIPAA if they’re aware that they will be traveling with people. You know, doesn’t that just take care of it right there? RON BAUMGART: I would have to defer to '}},
{ timecode: 4036, handler: 'blob', id: 290, data: {text: 'some of the other people on the panel that might be more familiar with the regulation. Dave White would probably be the one. DAVE WHITE: Well like I said, I’m not an expert, but I—so I '}},
{ timecode: 4046, handler: 'blob', id: 291, data: {text: 'would defer back to the information, the resource center. I do not recall HIPAA being a reason not to intermingle passengers. RON BAUMGART: The purpose of HIPAA is to provide protection to '}},
{ timecode: 4064, handler: 'blob', id: 292, data: {text: 'people’s health records. DAVE WHITE: Right. RON BAUMGART: And as a transportation provider, for the most part your not actually even part of that whole process of the health record, and so it '}},
{ timecode: 4077, handler: 'blob', id: 293, data: {text: 'shouldn’t actually ever come into play. DAVE WHITE: We as a broker, we have very stringent rules and regulations about how our manifest go out. About how what—you know, I can’t have '}},
{ timecode: 4090, handler: 'blob', id: 294, data: {text: 'protected health information open on desk, you know when people walk by, you know from the outside. There is whole—how are electronic records are kept. We take those regulations very seriously. '}},
{ timecode: 4110, handler: 'blob', id: 295, data: {text: 'How we talk on the phone to medical providers, how we exchange information, but I don\'t believe that there\'s anything in those regulations about people - passengers on vehicles. VALERIE'}},
{ timecode: 4125, handler: 'blob', id: 296, data: {text: 'MILLER: I think the issue comes when you are discussing it on a 2-way radio on an open radio. DAVE WHITE: Yes that right. VALERIE MILLER: That\'s an issue that you have to make sure and that, you'}},
{ timecode: 4136, handler: 'blob', id: 297, data: {text: 'know, that you have to make sure that drivers are not conversing about. DAVE WHITE: There\'s probably issues around NEMT if they transmitting information. VALERIE MILLER: Yes, but something on open'}},
{ timecode: 4150, handler: 'blob', id: 298, data: {text: 'wire that people are hearing on open span that people could be monitoring, but I don’t think – I think not too putting people on a common vehicle, especially if it’s a public vehicle '}},
{ timecode: 4170, handler: 'blob', id: 299, data: {text: 'and they know that they’ve contracted on a public vehicle. The only thing that could even possibly be an issue is if it’s a very specific clinic for a very specific issue. I '}},
{ timecode: 4189, handler: 'blob', id: 300, data: {text: 'don’t—I think that could be questionable, but I think that would be a specific incident that you’d have to work out. But other than that, I think it’s grasping. CHARLES '}},
{ timecode: 4204, handler: 'blob', id: 301, data: {text: 'DICKSON: I believe it is playing the HIPAA card. VALERIE MILLER: I know that there are states that put in, in the past, requirements that there are states that they can only be transported one at a'}},
{ timecode: 4222, handler: 'blob', id: 302, data: {text: 'time. There are states that they can only be transported with no other clients other than Medicaid clients. Quite frankly, and this is my opinion, it’s not the opinion of CTAA or anybody else. I '}},
{ timecode: 4238, handler: 'blob', id: 303, data: {text: 'think that we can’t afford to do that anymore. That we have gotten past that, but whether our rules and regulations have gotten past that or not, but I think it’s time that we address that '}},
{ timecode: 4250, handler: 'blob', id: 304, data: {text: 'because I simply don’t think we can afford it. So maybe the option is to say that HIPAA doesn’t allow it, and I think that’s a stretch. DAVID WHITE: I think what is going to'}},
{ timecode: 4261, handler: 'blob', id: 305, data: {text: 'override all the HIPAA card discussion is do you want to have adults with children, adults that you don’t know with children on vehicles. You generally don’t want to do that in this day'}},
{ timecode: 4277, handler: 'blob', id: 306, data: {text: 'and age. Do you want to have, you know, behavioral health issues, you know clients with behavioral health issues with clients that don’t have behavioral health issues. You probably don’t. '}},
{ timecode: 4290, handler: 'blob', id: 307, data: {text: 'But those are common sense issues—risk management issues that we take care of every day. But they have nothing to do with HIPAA. CHARLES DICKSON: Gentleman right there. AUDIENCE MEMBER: I think'}},
{ timecode: 4306, handler: 'blob', id: 308, data: {text: 'the biggest thing that you’re worried about, or I should say the facilities are worry about is not in relation to the HIPAA card specifically, it is education that your health care providers,'}},
{ timecode: 4318, handler: 'blob', id: 309, data: {text: 'your individuals who are in charge of setting this up. It is the education that they are getting. I know that from personal experience, when HIPAA first became an issue, hospitals, nursing facilities, '}},
{ timecode: 4332, handler: 'blob', id: 310, data: {text: 'they were going to their attorneys, and the attorneys are coming back saying you need to be educated, you need to be education, you need to be educated. And the education was quite simply if you '}},
{ timecode: 4342, handler: 'blob', id: 311, data: {text: 'release information about this person to somebody who does not need it, you’re going to get fined, you’re going to go to jail, you’re going to lose your license. Class is over. They '}},
{ timecode: 4350, handler: 'blob', id: 312, data: {text: 'literally scared everybody into, I can’t release any information, I can’t tell you. Sorry doctor but I don’t have them saying you can have the information so you can’t have it. '}},
{ timecode: 4361, handler: 'blob', id: 313, data: {text: 'It’s your patient but I am not going to tell you about them. That’s where a lot of the concerns I think in transportation are coming from because they say we are dropping off in front of a '}},
{ timecode: 4369, handler: 'blob', id: 314, data: {text: 'dialysis center so, therefore, it’s a dialysis client, and that’s what they’re worried about. In transportation it is going to be no different than getting off of a public bus, which '}},
{ timecode: 4379, handler: 'blob', id: 315, data: {text: 'is what she was saying. Your concern is going to be like I believe you said, is there information on your computer terminal in your vehicle that somebody can read. Are you calling a person’s '}},
{ timecode: 4391, handler: 'blob', id: 316, data: {text: 'name out over the radio that anybody with a $5.99 scanner from Radio Shack can pick up? That’s where your concern’s going to be, not whether or not you mutli-load them and by far the '}},
{ timecode: 4403, handler: 'blob', id: 317, data: {text: 'biggest concern is, like you said, are you putting a 7-year-old child with a 40, or a 60, 70-year-old individual at a nursing home who’s wearing a hospital gown and not regular clothing. '}},
{ timecode: 4416, handler: 'blob', id: 318, data: {text: 'That’s your concern. CHARLES DICKSON: Do we have another question. Okay. I would like to in the short time we have left just ask each of the panelists the same question. We will start with you, '}},
{ timecode: 4434, handler: 'blob', id: 319, data: {text: 'Michelle. What have been the biggest challenges that you face particularly in efforts of coordination and what have been the lessons that you have learned? What are the next steps for your project? So '}},
{ timecode: 4452, handler: 'blob', id: 320, data: {text: 'challenges, lessons, next steps. MICHELLE HANSEN: Well, I think that the biggest challenge so far was actually just staring and trying to get all the right people at the table. It was a little bit '}},
{ timecode: 4464, handler: 'blob', id: 321, data: {text: 'easier in South Dakota because it was very easy to access very quickly some of the key decision makers. When you have eleven transit agencies it was great to be able to get Ron so quickly and then '}},
{ timecode: 4475, handler: 'blob', id: 322, data: {text: 'also some of the key hospitals. That was I think our biggest challenge initially. The most important lesson we’ve learned I think so far is really try to start small and focused so that we can '}},
{ timecode: 4487, handler: 'blob', id: 323, data: {text: 'build up our sort of corridor system slowly. Really develop that one primary corridor and then turn it into two and hopefully turn into a plan that the rest of the state can replicate. As we already '}},
{ timecode: 4504, handler: 'blob', id: 324, data: {text: 'have one new transit agency that is already on board, I am really excited about that. So that has been one of our biggest successes. What is the last one? CHARLES DICKSON: Next steps. MICHELLE HANSEN: '}},
{ timecode: 4514, handler: 'blob', id: 325, data: {text: 'Next steps. Our next step is really working with, continuing to work with the health care industries to get them to focus on our route schedule. Tuesdays and Thursdays for long distances and helping '}},
{ timecode: 4528, handler: 'blob', id: 326, data: {text: 'them have more of a reflexive relationship with us in terms of being a transportation solution for them. Because again, the barrier of if it doesn’t meat my immediate need then I am just going '}},
{ timecode: 4541, handler: 'blob', id: 327, data: {text: 'to forget about it or file it away. We want to keep the service much more accessible on our fingertips. We hope they consider us a key resource for trying to meet their needs even if what we are '}},
{ timecode: 4551, handler: 'blob', id: 328, data: {text: 'providing today is not perfect. CHARLES DICKSON: Ron. New challenges, issues, next steps. RON BAUMGART: I think prior to putting together our team and going to institute, I felt the biggest challenge '}},
{ timecode: 4564, handler: 'blob', id: 329, data: {text: 'was I could never get a medical provider to really pay any attention to us if there was any value to that transportation that I was pretty sure the need was out there for. Certainly since we have '}},
{ timecode: 4576, handler: 'blob', id: 330, data: {text: 'teamed up and worked with the American Cancer Society and a couple of clinic, oncology clinics and some others that education process is starting to work on all ends. Everybody’s pitching in '}},
{ timecode: 4589, handler: 'blob', id: 331, data: {text: 'money for brochures; everybody is starting to ask the right questions. MICHELLE HANSEN: There is a little bit of jealousy with some providers not being included yet or some health care providers are '}},
{ timecode: 4598, handler: 'blob', id: 332, data: {text: 'not yet being apart of it. CHARLES DICKSON: So is that a challenge or is that a success? MICHELLE HANSEN: We are going to try to use that as a success. RON BAUMGART: And you’re right, there is. '}},
{ timecode: 4608, handler: 'blob', id: 333, data: {text: 'What logo goes where and what happens to this and we will pay for this if ours is on there. So those are some challenges, but I think probably as a transportation provider, my personal biggest '}},
{ timecode: 4621, handler: 'blob', id: 334, data: {text: 'challenge in this is make sure that we come up with something that is very workable. People will never want to rely on something they are afraid is going to go away, that will be there next month, '}},
{ timecode: 4631, handler: 'blob', id: 335, data: {text: 'next year. They always want to test the water for a while. We want to make sure this is there long into the future. It is sort of my job, as I tell all of the folks that work for me. It is my job to '}},
{ timecode: 4643, handler: 'blob', id: 336, data: {text: 'find the money it is your job how to figure how to get the ride done. We want to make sure as we build this into the future, that hopefully we can pick up a few partners and pick up those hospital '}},
{ timecode: 4655, handler: 'blob', id: 337, data: {text: 'sponsorships and things that will help defray some of the cost. It’s been really good for us to be able to mention to health care centers that we have a relationship working with the American '}},
{ timecode: 4667, handler: 'blob', id: 338, data: {text: 'Cancer Society and are certainly working on others to provide this. Certainly being from central South Dakota and working a lot with all the transits in the State of South Dakota, my goal is to see '}},
{ timecode: 4680, handler: 'blob', id: 339, data: {text: 'this go pretty much statewide. There are some very very rural areas, much more rural than we are that need this service as well so they can stay in their small communities and stay with their '}},
{ timecode: 4691, handler: 'blob', id: 340, data: {text: 'grandkids and their family farms and things that otherwise they’re going to have to gravitate to the 2 major medical centers in the state. CHARLES DICKSON: Pat the same for you the challenges '}},
{ timecode: 4704, handler: 'blob', id: 341, data: {text: 'that you faced and some of the issues and lessons learned, and what your next steps are going to be. PAT WEAVER: I think the challenges, when you look at it statewide, is that one size doesn’t '}},
{ timecode: 4717, handler: 'blob', id: 342, data: {text: 'fit all and some of the solutions and some of the slightly larger communities is more of an education, communication about the services that are there and it may be some filling in the gaps of you '}},
{ timecode: 4731, handler: 'blob', id: 343, data: {text: 'need some Saturday service or those kind of things versus the very rural areas, very remote areas and the much bigger challenges in that there is no transportation provider there right now. I think '}},
{ timecode: 4746, handler: 'blob', id: 344, data: {text: 'some of the issues were a little bit somewhat lack of data, lack of information so we feel like the study that we were involved with is helping to fill in the gaps. There is a lot more that needs to '}},
{ timecode: 4760, handler: 'blob', id: 345, data: {text: 'be done in that area to look beyond dialysis treatment and looking at other non-emergency medical transportation. I think some of the next steps really—I mentioned the more regionalization of '}},
{ timecode: 4777, handler: 'blob', id: 346, data: {text: 'transit service that helps move in that direction. We also have had efforts in our state and I know a lot of other states have been successful in terms of brokerages. We have not gotten there yet with '}},
{ timecode: 4794, handler: 'blob', id: 347, data: {text: 'Medicaid brokerage system, but in the case of dialysis treatment, there’s only a 30 percent or so population that eligible for Medicaid. That’s just a part of the solution. I think using '}},
{ timecode: 4810, handler: 'blob', id: 348, data: {text: 'the state council involvement of the Kansas Health Policy Authority as well as the other human service agencies at the state level to involve that all the way to the local level will be some of those '}},
{ timecode: 4824, handler: 'blob', id: 349, data: {text: 'next steps to help improve that service is available. CHARLES DICKSON: I think to me what I have taken out of this panel today is that is it the ongoing need for communication among the transportation '}},
{ timecode: 4839, handler: 'blob', id: 350, data: {text: 'providers and our partners in the medical field and social service field. It was just very interesting to me some of the things Michelle said about talking to social workers and what they were '}},
{ timecode: 4853, handler: 'blob', id: 351, data: {text: 'interested in. It was just as a point of information our partners at the Community Transportation Association and our employment transportation field have developed a new training program called '}},
{ timecode: 4866, handler: 'blob', id: 352, data: {text: 'Transportation Solutions Curriculum. This is really a training program that’s aimed toward educating folks who are not in the transit field about how to go about figuring out what transportation '}},
{ timecode: 4880, handler: 'blob', id: 353, data: {text: 'resources are available in their communities. I think that just stories that we’ve heard today from our panel point out how important it is for us as transportation professionals to make sure '}},
{ timecode: 4895, handler: 'blob', id: 354, data: {text: 'that folks are educated about what services are available, how to use them and how to most efficiently and effectively coordinate those services with the services they provide. More information can be '}},
{ timecode: 4910, handler: 'blob', id: 355, data: {text: 'found about that training on our website, which is CTAA.org. And that said, are there any questions out there at all for the panel? GINGER AMMON: We you mentioned the institute. Would you tell a'}},
{ timecode: 4925, handler: 'blob', id: 356, data: {text: 'little bit because we didn’t explain what the institute was? CHARLES DICKSON: Very quickly. We have been over the past couple of years been having an annual institute in Washington called the '}},
{ timecode: 4938, handler: 'blob', id: 357, data: {text: 'Institute for Transportation Coordination. Where we bring teams of people from the various communities around the country. Each community needs to provide a transportation person, a social service'}},
{ timecode: 4951, handler: 'blob', id: 358, data: {text: 'person, an employment person, and one other person who could come from the aging field or from local elected officials, medical field, to come together and work on a particular problem in Washington. '}},
{ timecode: 4965, handler: 'blob', id: 359, data: {text: 'It’s a several day session where it is interspersed with work sessions for each of the teams with educational sessions where people come together and talk about issues and coordination. It has '}},
{ timecode: 4980, handler: 'blob', id: 360, data: {text: 'been very successful in developing coordinated transportation programs around the country. I know that Michelle and Ron came with the team from South Dakota. That was really the impetus for their '}},
{ timecode: 4994, handler: 'blob', id: 361, data: {text: 'program there in South Dakota. And now we’re actually bringing those institutes to the states. We’ve done one state institute in Nebraska. We’ll be doing another one in Texas in '}},
{ timecode: 5008, handler: 'blob', id: 362, data: {text: 'August and in Massachusetts in October so if you’re interested in bringing one of those institutes to a state near you, just let me know. DAVID WHITE: Charlie let me just comment on the '}},
{ timecode: 5020, handler: 'blob', id: 363, data: {text: 'institute too. If sometime when you come to Expo and you have been to a few Expos, you sort of get the impression that the level—these are great sessions, they are wonderful but they’re '}},
{ timecode: 5031, handler: 'blob', id: 364, data: {text: 'kind of like 101, 201classes. But you go to institute and it is 301,401 or graduate level classes. They are really—I went to my first one last fall. It was really an outstanding intensive '}},
{ timecode: 5053, handler: 'blob', id: 365, data: {text: '– I was very pleased to see what CTAA has done with this institute, this coordination institute. CHARLES DICKSON: I can tell you these state institutes are really—the states are really '}},
{ timecode: 5064, handler: 'blob', id: 366, data: {text: 'pushing us to take even further. DAVID WHITE: Yeah. It’s a very intensely high level educational experience. Have we got it scheduled yet? When is the next one scheduled or has it been scheduled '}},
{ timecode: 5077, handler: 'blob', id: 367, data: {text: 'yet? CHARLES DICKSON: We have not scheduled the next national one. DAVID WHITE: You will get it out on the website. CHARLES DICKSON: So let’s have a round of applause for our panel.'}},
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